The word constipation is derived from the Latin word ‘constipare’, meaning to crowd together. The term constipation includes a wide range of symptoms and signs.

Studies have shown poor consumption of fluids as the second independent risk factor. These results support the observation that constipation is a ‘summer disease’ that may be treated by increasing the intake of fluid. The simplest definition of constipation is the difficulty of the passage of large or hard stools. Constipation is usually defined in terms of changes in the frequency, volume, weight, consistency or ease of passage of the stool. In children, stool frequency depends on age. By the age of four, an adult pattern of bowel movement is achieved.

In children with earlier constipation, the parent should pay attention to the child’s stool frequency during holidays or travel in summer.

Low fluid intake alone does not cause constipation. Summer and the high humid weather leads to loss of electrolytes like sodium or Potassium. When kids can’t or won’t use the bathroom, it’s called “withholding”. Cleanliness can also be an important factor. Nearly 20% dislike using outside bathrooms because they’re dirty and an outdoor setting is less likely to have clean restrooms. This can further discourage one from going.

Non-availability of toilet facilities and postponing defecation is one important factor. Continuing to resist the urge to go can cause the brain to begin to ignore the urge as well. This avoidance of going to the bathroom is one of the most common causes of constipation. Low food intake and intake packed food lead to impaction. The most common type of constipation in children is simple constipation.

In the elderly, low liquid intake may be indicative of hypohydration, often thought to be a cause of constipation. Poor dentition, a decreased production of saliva and dehydration, especially in the warmer months makes the problem more.

How do you diagnose constipation?

It is difficult to define and quantify as to what is and what is not constipation. There are persons who evacuate the bowels three to four times daily. At the other end, are those persons who visit the toilet once in three or four days and are none the worse for it. Subjectively, hard stools, difficult stools, bulky stools or small stools and sometimes painful stools have all been regarded as constipation by the patient. Possibly the occurrence of a backlog in the bowel with a tendency for more and more stools to be retained every day may be the best definition for constipation. But this cannot be quantified until symptoms manifest.

Studies have been made to find out the time taken for the ingested food to make its journey from the mouth to the anus, using radioactive racers tagged to food. The transit time has been found to vary from about 20 hours to 96 hours or more. The Asiatics have a more rapid transit, which is attributed to the vegetarian high fibre diet. Possibly their relative lack of inhibitions to defecate often performed on an as-is-where-is basis may also be a contributing factor to the rapid transit.

The western counterpart has a much lower transit period. It may be relevant to state that the higher incidence of colon disorders like cancer, colitis and diverticolitis, may be the price paid for by the westerners by this delay of transit.

What can cause constipation?

Drugs can cause constipation. In adult and in elderly people, the importance of the use of drugs such as narcotics, antihypertensive medications, diuretics, antacids containing aluminium and the long-term use of stimulants or bulk-forming laxatives may cause impaction. One myth is that waste products can accumulate and contaminate the rest of the body.

A host of medications can cause constipation, including iron and calcium supplements, antidepressants, painkillers, and some blood-pressure drugs. Constipation can occur in pregnancy or be caused by serious conditions, such as an underactive thyroid, elevated blood-calcium levels, Parkinson’s disease, multiple sclerosis, irritable bowel syndrome, and actual blockages of the intestine by colon cancer. All can cause difficulty in moving one’s bowels.

The great part about summer is that it keeps kids active, which helps prevent constipation.

Dehydration is related to water itself, but under certain conditions, dehydration can cause constipation. Constipation during the summer season is often seen because people are dehydrated. During the summertime, the water that is present in the digestive system is diverted to control the body temperature. Water is released in the form of sweat and water vapour.

The role of fluids:

Fluid losses induced by diarrhoea and febrile illness alter water balance and promote constipation. When children increase their water consumption above their usual intake, no change in stool frequency and consistency was observed. The improvement of constipation by increasing water intake, therefore, may be effective in children only when voluntary fluid consumption is lower-than-normal for the child’s age and activity level.

While sulphate in drinking water does not appear to have a significant laxative effect, fluid intake and magnesium sulphate-rich mineral waters were shown to improve constipation in healthy infants.

In conclusion, fluid loss and fluid restriction and thus de-or hypohydration increase constipation. It is thus important to maintain hydration as the prevention of constipation. The prevalence of mood and anxiety disorders in constipated patients is much higher than the general population.

Constipation is a social disease. The environment also plays a major role in this ailment. Even travel to another place is known to inhibit bowel movement. Mental tension, change of duty hours, jet lag, a dirty toilet are well known to contribute towards inhibitions of the bowel movement. The other contributing factors include low intake of fluids especially in summer, low residue diet, the growing use of fast food or a liquid diet, which may be worse confounded by an illness where such a diet is needed, and metabolic disorders like diabetes. In diabetes apart from the excessive loss of fluids as urine, the associated neuropathy (nerve degeneration) of the bowel may lead to the slowing of the bowel.